316 



Clots of blood in the nasal passages must be washed out, collections 

 of pus must be removed from the sinuses, and if the teeth are loos- 

 ened and likelj^ to fall out they should be removed. If roaring is 

 threatened, tracheotomy is indicated. 



Fractures of the pre-maxillary hone. — These are mentioned by con- 

 tinental authors. They are usually encountered in connection with 

 fractures of the nasal bone, and may take place either in the width 

 or the length of the bone. 



The deformity of the upper lip, which is drawn sidewise in this 

 lesion, renders it easy of diagnosis. The abnormal mobility and the 

 crepitation, with the pain manifested by the patient when undergoing 

 examination, are concurrent symptoms. Looseness of the teeth, 

 abundant salivation, and entire inability to grasp the food complete 

 the symptomatology of these accidents. In the treatment, splints of 

 gutta percha or leather are sometimes used, but they are of difficult 

 application. Our own judgment and practice are in favor of the 

 union of the bones by means of metallic sutures. 



The loiver jaw. — A fracture here is not an injurj^ of infrequent 

 occurrence. It involves the body of the bone, at its symphysis, or 

 back of it, and includes one or both of its branches, either more or less 

 forward, or at the posterior i^art, near the temporo-raaxillary articu- 

 lation, at the coronoid process. 



Falls, blows, or other external violence, or powerful muscular con- 

 tractions during the use of the speculum, may be mentioned among 

 the causes of this lesion. The fracture of the neck and of the 

 branches in front of the cheeks causes the lower jaw, the true dental 

 arch, to drop, without the ability to raise it again to the upper, and 

 the result is a peculiar and characteristic physiognomy. The pre- 

 hension and mastication of food become impossible; there is an 

 abundant escape of fetid and sometimes bloody saliva, especially if 

 the gums have been wounded ; there is excessive mobility of the lower 

 end of the jawbone; and there is crepitation, and frequently par- 

 alj^sis of the under lip. But although the aspect of an animal suffer- 

 ing with a complete and often compound and comminuted fracture of 

 the submaxilla presents at times a frightful spectacle, the prognosis 

 of the case is comparatively simple, and recovery usually only a ques- 

 tion of time. The severity of the lesion corresponds in degree Avith 

 that of the violence to which it is due, the degree of simplicity or the 

 amount of complication, and with the situation of the Avound. It is 

 simple when at the symphysis, but becomes more serious when it 

 affects one of the branches, to be again aggravated when both are 

 involved. Fracture of the coronoid process becomes important prin- 

 cipall}^ as an evidence of the existence of a morbid diathesis, such as 

 osteoporosis, or the like. 



The particular seat of the injury, with its special features, will 

 of course determine the treatment. For a simple fracture without 



